I hereby certify that the answers to the foregoing questions are true to the best of my knowledge.

I understand that employment is contingent upon satisfactory completion of reference checks.

Should a job offer be made, I consent to taking a pre-placement physical examination and such future examinations as may be required and provided by the employer.

I understand that any job offer or my continuing employment, if hired, is contingent upon being physically, mentally, and medically able to successfully perform the essential job functions of my position. I agree that the results of my medical/health screen may be released to appropriate agencies in the event of a worker's compensation injury and/or dispute on payment of a medical claim.

I understand that as a part of my pre-employment physical examination, upon which my offer of employment is contingent, I will be required to successfully pass a drug screening test, which will require me to provide a urine specimen for analysis. The urine specimen will be analyzed for the presence of marijuana, cocaine, phencyclidine (PCP), opiates, and amphetamines.  Results of the drug test are confidential, and will not be disclosed with others.  My consent below specifically signifies my consent to this pre-employment drug screening test, or subsequent tests as required.

I agree to wear or use all protective clothing or devices required by the facility and to comply with all safety policies and procedures.

I understand that any omission, misrepresentation, or falsification can be grounds for refusal of employment or immediate termination.

I understand that if I am hired and wish to quit this position in the future, that I will give at least 2 weeks notice before leaving this position.